Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management.
OBJECTIVE
Adults with scoliosis often present with neurological symptoms and deficits. However, the incidence of these findings and how they may affect treatment decisions have not been clearly defined. The purpose of this study was to quantify the prevalence of neurological symptoms and deficits in adults with scoliosis presenting to a surgical clinic, and to assess for an association between these factors and the decision to pursue operative treatment.


METHODS
In this study, the authors document the Oswestry Disability Index (ODI), radiographic findings, and the incidences of back pain, neurological symptoms (radiculopathy and claudication), and neurological deficits (weakness, myelopathy, and bowel/bladder dysfunction) and correlate these with operative versus nonoperative management. Pain was assessed using the visual analog scale (VAS) score. Of 207 patients, 25% underwent surgery.


RESULTS
Incidences of back pain (VAS score > 0 points) and radiculopathy (VAS score > 0) were 99 and 85%, respectively. The incidences of severe (VAS score > 5) back pain and radiculopathy were 66 and 47%, respectively. Neurological symptoms and deficits included weakness in 8% of patients, claudication in 9%, myelopathy in 1%, and bowel/bladder dysfunction in 3%. Patients with severe radiculopathy had greater mean ODI scores (p < 0.001) and reduced lumbar lordosis (p = 0.04) and were more likely to have de novo scoliosis (p = 0.009). Patients who underwent surgery had higher ODI scores (p < 0.001) and a greater incidence of severe radiculopathy (p = 0.006), weakness (p < 0.001), and neurogenic claudication (p = 0.003). Factors associated with operative management on multivariate analysis included weakness (p < 0.001), severe radiculopathy (p = 0.02), and sagittal imbalance (p = 0.03).


CONCLUSIONS
Neurological symptoms and deficits are common among adults with scoliosis. Development of neurological symptoms and/or deficits is strongly associated with the decision to pursue operative treatment.
Smith
Justin S
JS
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Fu
Kai-Ming
KM
Urban
Peter
P
Shaffrey
Christopher I
CI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000523:psychology / Q000601:surgery; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications* / Q000523:psychology* / Q000601:surgery; D012720:Severity of Illness Index